Post-visit note -- meds to take, notes generated to give to patients, so no ICD-10 codes - needs to be patient friendly, not the full med list - just what changed/discussed

Post-visit note -- meds to take, notes generated to give to patients, so no ICD-10 codes - needs to be patient friendly, not the full med list - just what changed/discussed

+

+

Some of this can vary by organization, such that some orgs will treat HIM query as clinical notes and some don't

Which resource?

Which resource?

* Eric and Rob agree NO observation because the note is more like an impression

* Eric and Rob agree NO observation because the note is more like an impression

* In the past, one argument against "a Composition defines the structure, it does not actually contain the content" but Brett said that the content of each section *can be* included in the Composition section

* In the past, one argument against "a Composition defines the structure, it does not actually contain the content" but Brett said that the content of each section *can be* included in the Composition section

−

* Is Composition too heavy? Does it warrant a new resource if it is "composition-lite"

* Eric will add to an existing tracker a comment about the contradictory statements. Scope of Composition is "While a Composition defines the structure, it does not actually contain the content" but later on Composition.section.text says "A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative."

* Eric will add to an existing tracker a comment about the contradictory statements. Scope of Composition is "While a Composition defines the structure, it does not actually contain the content" but later on Composition.section.text says "A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative."

+

* CCDA can include some clinical notes as a section (note section; entry is note activity)

+

+

Composition Cons

+

* Is Composition too heavy? Does it warrant a new resource if it is "composition-lite"?

+

* Composition isn't named intuitively

+

* Not many vendors have implemented Composition (e.g. Cerner, Epic, Allscripts is starting to implement Composition)

Comments or annotations are not discoverable on their own. Comments or annotations are discovered as part of a medication, procedure, observation.

Notes can be discovered on their own and the note generally summarizes structured data.

Post-visit note -- meds to take, notes generated to give to patients, so no ICD-10 codes - needs to be patient friendly, not the full med list - just what changed/discussed

Some of this can vary by organization, such that some orgs will treat HIM query as clinical notes and some don't

Which resource?

Eric and Rob agree NO observation because the note is more like an impression

In the past, one argument against "a Composition defines the structure, it does not actually contain the content" but Brett said that the content of each section *can be* included in the Composition section

Eric will add to an existing tracker a comment about the contradictory statements. Scope of Composition is "While a Composition defines the structure, it does not actually contain the content" but later on Composition.section.text says "A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative."

CCDA can include some clinical notes as a section (note section; entry is note activity)

Composition Cons

Is Composition too heavy? Does it warrant a new resource if it is "composition-lite"?

Composition isn't named intuitively

Not many vendors have implemented Composition (e.g. Cerner, Epic, Allscripts is starting to implement Composition)

Opinions about which resource to use varies a little bit

Prior Action Item Follow-up

Condition

QA 4a. Condition.category is CodeableConcept with FHIR-defined value set - related to past GF#11091 -- Rob H. provided an update -- this is still an open question with next step to talk to Grahame and Ted.

revisit GF#13026 Condition.clinicalStatus -- Rob will consult with SNOMED and Stephen's PPT is attached to the tracker

Procedure - questions about splitting Procedure (performed) vs ProcedureStatement (history/ patient stated) - need to draft resources as a starting point and sync with Russ on whether we need a more generic patient activity statement resource

Procedure statement is a good idea. Need to broaden the concepts to other activities. Idea is to have activity statement and then profile it specific to procedure. A patient statement about their exercise or nutritional intake or their ADLs, these are different

Who are the actors that would use this - patient statement and carer statement but can be an activity statement that a provider can use as secondary information. Scope includes provider use as well.

PMH - where it should be possible do distinguish surgical or diagnostic procedure from when the patient reported the procedure. Post surgery, the surgeon will make an interventional procedure report. This is different. FHIR has a procedure report. OO part would be the diagnostic report (report of findings) and the report that is interventional - these are two different reports. How does FHIR separate the two. And how does FHIR handle the real world where these are combined? Ultrasound guided biopsy would be a diagnostic report with findings (description of the procedure and description of findings).

There is an extension that adds the types of terms that you would see on the procedure.

Might be a more general solution but it's not settled.

Standard operative report has a description of the procedure and a section that deals with findings.

meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.

ClinicalImpression is not mature enough to resolve this issue. Ask MnM for an exemption on the QA checklist (re: Condition having a circular reference with ClinicalImpression)

Add note: "A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation"

Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task